POS1594-HPR A REGIONAL MULTICENTRE REVIEW OF THE DELAY TO DIAGNOSIS IN PATIENTS WITH AXIAL SPONDYLOARTHRITS- HOW WELL ARE WE DOING? RESULTS FROM THE SCAN GROUP (UK)
Authors: G. Dulay, C. Boys, A. Chan, A. Coy, M. Devin, L. Goh, A. Mcdougall, K. Rigler, J. Tomkins, D. Wallis, E. Williams
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Due to the insidious onset and non-specific nature of axial spondyloarthritis (AxSpA), there is often a significant delay to diagnosis. The average delay to diagnosis in the UK is 8.5 years <sup>[1]</sup>. This is associated with several adverse sequalae including poor disease-related quality of life and worse overall health outomes <sup>[2,3]</sup>. In addition, there are substantial health-economic costs associated with this. Recent modelling data in the UK, commissioned by the National Axial Spondylarthritis Society (NASS), demonstrated the average financial cost of this delay to be £196,000 (221,000 Euros) per person affected <sup>[1]</sup>. There is a focus on reducing diagnostic delay for patients with AxSpA. The SCAN (South Central Axial Spondylarthritis Network) is a network of NHS (National Health Service) Rheumatology departments in hospitals across south-central UK. The group comprises of; doctors, nurses and physiotherapists. SCAN has a working interest in service development. <h3>Objectives</h3> The SCAN group carried out a service evaluation to establish the average delay to diagnosis for patients with AxSpA across our region. Data was gathered from a total of 7 hospitals within the SCAN region. We also aimed to assess the degree of variability across the 7 different hospitals. The baseline data will be used to support potential implementation of service development initiatives, which in turn, will aim to ultimately reduce the delay to diagnosis for patients with AxSpA across the SCAN region. <h3>Methods</h3> Retrospective patient data was collected from 7 different hospitals within the SCAN network area. Data was gathered on 5-10 sequential cases of newly diagnosed AxSpA at each hospital. A total of 65 cases were included in our dataset. Data was collected on; date of symptom onset, date of diagnosis, age and gender. <h3>Results</h3> Chart 1 summarises our main findings across the 7 different hospitals. Based on our representative sample from our region, the overall average (mean) delay to diagnosis in the SCAN area hospitals is 4.6 years. This is new data. The average age of the patients was 37 years old and 70% of the patients were male. The range for delay to diagnosis across the 65 cases was from 1 month to 30 years. The observed variability between the hospitals may be related to sample size, differences within local referral systems or reflective of areas where primary care education has been undertaken. Whilst acknowledging the relatively modest size of the sample, this regional multicentre dataset has allowed us to importantly establish what our average delay to diagnosis is for patients within the SCAN region. This valuable information will provide support for planning and implementation of further regional service improvements. <h3>Conclusion</h3> Our data suggests the delay to diagnosis within our region is significantly shorter than the national average (4.6 years versus national average 8.5 years). However, this delay remains unacceptably long and is likely to be associated with worse disease-related quality of life and a wider detrimental socio-economic impact. The SCAN group will consider introducing changes to the referral processes (<i>e.g.,</i> an agreed single referral proforma with local education). We may also aim to replicate any successful local arrangements in place at those hospitals with the shortest delay to diagnosis. We aim to re-evaluate the delay to diagnosis across the SCAN region in 12-36 months where we are optimistic of demonstrating further progress with reducing diagnostic delay for our patients with AxSpA. <h3>References</h3> [1]https://nass.co.uk/news/cost-of-delayed-diagnosis [2]Doward LC, Spoorenberg A, Cook SA, Whalley D, Helliwell PS, Kay LJ, McKenna SP, Tennant A, van der Heijde D, Chamberlain MA. Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. <i>Ann Rheum Dis.</i> 2003;62:20–26. [3]Yi E, Ahuja A, Rajput T, George AT, Park Y. Clinical, economic, and humanistic burden associated with delayed diagnosis of axial spondyloarthritis: a systematic review. <i>Rheumatol Ther.</i> 2020;7:65–87. <h3>Acknowledgements</h3> This abstract is produced and submitted on behalf of the entire SCAN group. <h3>Disclosure of Interests</h3> Gurdeep Dulay Speakers bureau: Previous unrelated paid speaker fees/advisory board fees for: Roche, Chugai, Lilly, Sandoz, Thornton-Ross, Amgen, UCB, Abbvie, Gilead, Janssen., Catherine Boys: None declared, Antoni Chan: None declared, Aisling Coy: None declared, Mary Devin: None declared, Leslie Goh: None declared, Arran McDougall: None declared, Kathryn Rigler: None declared, Jacqui Tomkins: None declared, Dinny Wallis: None declared, Emma Williams: None declared.